Abstract
Aim
Intravesical Botulinum Toxin Type A (BoNT-A) is a common treatment for overactive bladder symptoms refractory to anticholinergic and beta-3 agonist medications. Urinary tract infection rates of < 10% are commonly reported for flexible cystoscopy. We aimed to establish whether local anaesthetic flexible cystoscopy BoNT-A treatment could be performed with an acceptable rate of infection and morbidity without prophylactic antibiotics.
Method
Prospective audit of patients treated with local anaesthetic intravesical BoNT-A over 8 weeks. A telephone questionnaire was administered at 10 to 17 days post-procedure assessing symptoms, infection and antibiotic use. Electronic records were used to review pre-procedure urine analysis and post-procedure urine culture. Antibiotic use and positive cultures within 10 days were considered significant.
Results
51 (76%) of the 67 patients treated were contacted by telephone. These consisted of 41 female and 10 male patients with mean (range) age of 58 (25 to 86) years. 35 (69%) reported being asymptomatic or having symptoms as expected and 2 (4%) patients reported symptoms worse than expected following the procedure. 14 (27%) reported having a urinary tract infection with 9 (18%) provided with antibiotics. Positive urine cultures were present in 5 (10%) patients. Pre-procedure urine analysis, patient age, history of recurrent infection and catheter use did not predict post-procedure urinary tract infection.
Conclusions
Patients reported higher levels of infection and antibiotic use than expected. Patients should be well counselled about symptoms and complications to minimise antibiotic use. Further work is planned to establish whether prophylactic antibiotics will reduce symptomatic infections, antibiotic use and healthcare interactions post-procedure.
Susceptibility of the Index Urinary Tract Infection to Prophylactic Antibiotics Is a Predictive Factor of Breakthrough Urinary Tract Infection in Children with Primary Vesicoureteral Reflux Receiving Continuous Antibiotic Prophylaxis
